Emergency Emergency – the perilous state of Emergency care provision in Northern Ireland

Much has been made in the press in recent days about the crisis in local hospitals. Planned surgery has been cancelled to cope with the deluge in Accident and Emergency units. The system is certainly under strain and medical staff are under significant pressure. I thought it would be interesting to crunch the numbers to see how the difficulties being faced here compare to those in Britain.

There is a nationwide target in Emergency units to treat, discharge, or admit 95% of A&E cases within four hours (the target is 98% in Scotland). Northern Ireland has, by far, the worst performance of the four UK constituent regions/countries. Since 2008, when Northern Ireland statistics on A&E performance start, a significant gap has opened up between performance in Northern Ireland and that in Great Britain in “Type 1”, or major 24 hour Emergency units.

Nation Comparison

What started as a gap of 8% has grown to a gap of more than 20%, and with the crisis in recent weeks, the trend is liable to worsen (in the graph above, Q1 starts in April, so the data runs until September 2014).

In fact, of all the 51 NHS Regional Units (Trusts or Area Teams) in the UK in September 2014, all three of the worst performing were in Northern Ireland; Belfast, Northern, and the South Eastern HSC Trusts. The Royal Victoria hospital dealt with 64.5% cases within four hours, in the Mater the figure was 67.9%. These were, by some distance, the worst performing Emergency units in all of the UK.

So, what is the reason for this poor performance? Is it due to an unprecedented spike in demand? In fact, there hasn’t been a spike in demand. Numbers presenting themselves to Emergency units have remained relatively stable, with predictable seasonal fluctuations, over the last seven years.

NI New Cases

So, if cases have remained stable and followed a predictable seasonal variation, what could be to blame for the poor performance of Northern Ireland hospitals compared to those in Britain? Is there a significant difference in health spending per head? Well, there is indeed.

Health Spending per head

This 2012 report of the National Audit Office shows that health spending per capita is higher in Northern Ireland than it is in England, Scotland or Wales.

So, we are left with something of a mystery. Since the reestablishment of the Northern Ireland Assembly, the performance of Accident and Emergency units has markedly deteriorated compared to those in Great Britain, whilst per capita spending has remained the highest in the UK. Are we entitled to ask why we are receiving a second rate service? It certainly isn’t due to any failing in the professionalism and hard work of hospital medical staff who, whilst I don’t have hard data to hand to back this up, in my experience perform their jobs with heroic skill and care in very difficult circumstances. But the fact remains, in terms of waiting times, Northern Ireland has the worst Accident and Emergency provision in the UK. Why?

A qualified accountant and data analyst, interested in politics, economics and data. Twitter: @peterdonaghy